Each February, we recognize American Heart Month, a time to raise awareness for heart health. Cardiovascular disease is the nation’s leading cause of death in both men and women, killing nearly 610,000 people each year. One common and serious heart valve problem that can be deadly is aortic valve stenosis, which affects more than 2.5 million Americans older than 75.
Aortic valve stenosis refers to the narrowing of the aortic valve opening, which restricts blood flow from the heart into the aorta, the main artery that carries blood away from the heart to the rest of the body. A minimally invasive, relatively new surgical procedure called transcatheter aortic valve replacement, or TAVR, helps treat patients with a narrowed aortic valve.
Unlike traditional valve replacement surgery, with TAVR, surgeons do not have to perform an open-heart procedure in which the chest is surgically separated. The TAVR procedure only requires small incisions.
Aortic valve stenosis can be caused by a variety of medical issues, including wear and tear on the heart over time, calcium buildups on the heart valve, and congenital abnormalities. Narrowing of the aortic valve keeps the valve from opening fully, reducing blood flow to the body and making the heart work harder. Because it is working in overdrive, the heart may weaken, causing heart failure, chest pain, fatigue and shortness of breath.
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Without aortic valve replacement, people who have developed symptoms from severe aortic stenosis face a 50 percent chance of death within two years of diagnosis. Aortic valve replacement helps to relieve symptoms and improve the survival outcomes of those with severe aortic stenosis.
The TAVR procedure is designed for patients with severe aortic stenosis who are at a moderate to severe risk of complications with traditional open-heart surgery, such as elderly patients. Before the development of the TAVR procedure, treatment was limited for patients with severe aortic stenosis who were considered too high risk for open-heart surgery.
During the TAVR procedure, a cardiologist and cardiothoracic surgeon work together to implant a new heart valve in the patient, through a small puncture in the groin. The valve is inserted by a needle puncture to the skin and through a catheter, without open-heart surgery. Because this procedure doesn’t require a large chest incision, patients recover much faster and can typically return home after two or three days in the hospital.
This procedure is usually performed while the patient is under conscious sedation, rather than general anesthesia. Conscious sedation is like sleeping, as patients are not aware of their surroundings, but breathe on their own.
TAVR can be an effective way to improve the quality of life for those suffering from aortic valve stenosis. More than 45,000 successful procedures have been performed in the United States. If you or a loved one are suffering from this valve disorder, talk to a cardiologist to see if TAVR may be an option.
Dr. Nezar Falluji, an interventional cardiologist, is the director of the Structural Heart Program at Saint Joseph Hospital.